P-4 HETEROGENEITY OF PRE-LIVER TRANSPLANT EVALUATION PRACTICES IN LATIN AMERICA COUNTRIES: THE LIVER TRANSPLANT ALEH SPECIAL INTEREST GROUP, INTERNATIONAL SURVEY 2023

• Published in: Annals of hepatology Vol. 29; p. 101191
• Main Authors: Mainardi, Victoria, Menéndez, Josemaría, Gerona, Solange, Villamil, Alejandra, Pages, Josefina, Mendizabal, Manuel, López, Sergio, Varon, Adriana, De Medeiros, Alfeu, Abad, Jhon, Restrepo, Juan Carlos, Codes, Liana, Lisboa, Paulo, Perez, Norma Marlene, Coste, Pablo, Castro-Narro, Graciela, Padilla, Martin, Terrabuio, Débora Raquel B., Guimaraes, Mario, Girala, Marcos, Lucca, Leonardo, Aguilera, Edgard, Urzúa, Álvaro, Samada, Marcia, Valenzuela, Kenia, Zapata, Rodrigo
• Format: Journal Article
• Language: English
• Published: Elsevier España, S.L.U 01-02-2024
• ISSN: 1665-2681; 2659-5982
• DOI: 10.1016/j.aohep.2023.101191

Latin America (LA) includes 20 countries, with significant cultural and economic diversity. In order to develop regional liver transplant (LT) guidelines, the LT ALEH special interest group (SIG) made a survey aimed at investigating the current status of pre- LT evaluation in LA.
A 150 questions-survey was distributed to LT-SIG members in 01-05/2023. A descriptive analysis was performed.
20 answers from 14 countries were obtained. All countries performed LT except one. Financing was private in 5%, public in 32% and mixed in 63%. Allocation system was MELD-Na/MELD in 70 and 30%, respectively. Hepatocellular carcinoma granted supplementary points except in one country. Expansion of Milan criteria was acceptable in 9 centers (UCSF, Up to 7, AFP model, Milan/Brazil). Effective downstaging applied to LT except in 2 centers and AFP>1.000 was a contraindication in 10 centers. Three centers performed LT for cholangiocarcinoma and 4 for colorectal liver metastasis. Acute Liver failure had emergency prioritization in all but 2 countries. Age>65 was a contraindication in 1, >70 in 2 and >75 in 4 centers. Body Mass Index>40 was a contraindication in 8, and <18 in 2 centers. Fragility score7 was a contraindication in 1 center. A period of alcohol abstinence was required by 14 centers (3-6 months), as well as for tobacco in 4, cannabis in 7 and cocaine in 14. VIH was a contraindication in 7 centers and portal thrombosis in 3. Other contraindications were: coronary artery disease requiring surgery (8 centers), dynamic intraventricular gradient>80 mmHg (8 centers), hepatopulmonary syndrome with severe hypoxemia (14 centers), severe or moderate portopulmonary hypertension (7 and 10 centers, respectively).
Pre-LT evaluation in LA is very heterogeneous. The collaborative sharing of experiences between countries and the development of regional guidelines will be relevant in order to unify criteria and improve LT access.